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RITE AID OF NEW YORK, INC.
RRC330011-00 OUR LADY OF LOURDES MEMORIAL HOSP
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Covered Entity Details
Entity Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330011-00
Entity Address
169 RIVERSIDE DRIVE
BINGHAMTON, NY 13905
Medicare Provider Number
330011
Participating Start Date
7/1/2024
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #2749
119 WEST MAIN STREET
HANCOCK, NY 13783
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/20/2018
Ownership change
Contacts
Covered Entity Signing Official
Kathryn Connerton, CEO
(607) 798-5328
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/14/2016
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